Provider Demographics
NPI:1093098196
Name:THOMAS, NANCY LYNN (MSN,ANP-BC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSN,ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 HOSPITAL DR
Mailing Address - Street 2:DIALYSIS UNIT
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9806
Mailing Address - Country:US
Mailing Address - Phone:603-653-3830
Mailing Address - Fax:
Practice Address - Street 1:1080 HOSPITAL DR
Practice Address - Street 2:DIALYSIS UNIT
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-9806
Practice Address - Country:US
Practice Address - Phone:603-653-3830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-25
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH038912-23363LA2200X
MECNP131097363LA2200X
VT101.0087558363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1033932Medicaid
NH3114377Medicaid